FAQs
Thinking about a career in radiation oncology? Learn more about the field and explore frequently asked questions on application and interview process. In addition, take advantage of helpful resources for medical students interested in radiation oncology. The FAQs below come from our bi-monthly Medical Student Q&A sessions. If you have additional questions, please feel free to join the Q&A sessions.
What is radiation oncology?
Radiation oncology is a field in medicine that uses ionizing radiation to treat patients with cancer and other benign conditions such as trigeminal neuralgia and keloids. The goal is to deliver radiation precisely to a defined target while providing minimal damage to surrounding normal tissue.
How did you become interested in radiation oncology?
Interest in radiation oncology comes in a variety of ways and timelines. Some radiation oncologists knew they were at least potentially interested in the field prior to or early in their medical training. Others were exposed to radiotherapy during their clerkships. Most gained experience through shadowing and formal rotations, during which they often describe being drawn to the population of patients with cancer and the compassionate and longitudinal care that radiation oncologists can offer, the problem-based approach to patient care, and/or the technical aspects of radiation treatment planning and delivery. If you think you may be interested in radiation oncology, shadowing, talking more with current residents and radiation oncologists, and possibly research experiences are good ways to learn more.
How should a medical student begin to learn about radiation oncology? How can they get involved at their home institutions?
Shadow shadow shadow! Radiation oncology is a small field and personal connections really go a long way. Feel free to email the rad onc at your home institution or just walk in to the department and ask for more information! If your home institution has a residency program, they will always have research opportunities for you to get involved. If your home institution doesn't have a residency program, that is okay! Find a smaller local practice; the rad onc should still be able to help provide opportunities and connections in the area.
Where is radiation oncology as a specialty headed?
Radiation oncology is an ever-advancing field! We continuously strive to not only advance our own field, but also how our treatment interacts with medical and surgical oncology. From a technology standpoint, our latest technologies include magnetic resonance linear accelerators (MR-LINACs), adaptive radiation therapy (where every day, a new radiation plan is made based on that day's anatomy), constant updates on image guidance and motion management, and new indications for radiation therapy. We also work closely with medical oncology to see how radiation and systemic therapies can work synergistically, especially with the increase in targeted therapies. We are also working with our nuclear medicine, radiology and interventional radiology colleagues on radiopharmaceutical and other targeted therapies.
What is the risk of getting cancer as a physician who works with radiation on a regular basis?
Studies have revealed that in the modern age of radiation oncology in the United States that there is no increased risk for a cancer or increased risk birth defects to progeny. In addition, all of the staff that work in the department wear film badges to track the amount of radiation exposure. Most radiotherapy procedures involve external beam radiotherapy, where there is virtually no radiation exposure to anyone but the patient in the treatment room undergoing radiotherapy. Some less common radiotherapy procedures do involve radioactive sources, such as brachytherapy and radiopharmaceutical administration, and very limited radiation exposure may be expected in these scenarios.
What does a typical day as a radiation oncologist look like?
Schedules can be very different depending on the type of radiation oncologist job you have! In the private or community setting, many see patients four to five days per week with patient care being the priority. In larger practices, you may have an administrative day or time for leadership/career/research development. In the academic setting, most radiation oncologists see patients three to four days per week, with one to two days of administrative/research time. Within academics, there are wide variations of research careers depending on the type of research and institution.
Otherwise, a typical clinic day is similar across practice types. There may be a morning (maybe 7:00 a.m.?) multidisciplinary tumor board to attend, followed by patients (consultations, follow-ups, simulation scans, brachytherapy) from 8:00 a.m. to noon. At the noon hour, there may be another tumor board, meeting, free time, or a patient add-on, if you want. In the afternoon, you have more patient-facing time. Most radiation oncologists finish seeing patients by 5:00 p.m. every day, unless they are on call. There are only a few instances when radiation oncologists work after hours. One instance is if the department is still treating patients — in this case, practices need to have a physician on site until treatments are done. The other instance is call; typically, after-hours call is taken from home, but radiation oncology urgencies can happen, which may require seeing a patient in the hospital or clinic on a more urgent basis.
What do you look for in a mentee?
We look for someone who is dedicated, driven and passionate about the field of radiation oncology. Mentees should express their continued eagerness to learn and have a strong work ethic. In addition, a mentee who is open to feedback, willing to learn from mistakes and committed to continuous improvement will thrive in this field. This adaptability shows they’re invested in their long-term development and have the humility to grow.
Is radiation oncology still a good field to consider if you are not heavily interested in research?
YES it certainly is! Most Rad Oncs in the country don't predominately focus on research. Many focus primarily on their clinical duties, and if possible, enroll patients into clinical trials. I know it seems like applying for RadOnc and being a resident in the field is all about Research Research Research. It certainly helps when applying, but when it comes down to it, the most important thing is mastering the art of radiation oncology and learning how to best treat your patients.
What is the field of radiation oncology currently doing to improve diversity and inclusion?
The field of radiation oncology is actively working to improve diversity and inclusion by building a supportive pipeline for underrepresented students and early-career professionals. Key initiatives include targeted outreach, recruitment, and structured support programs for medical students from diverse backgrounds. For instance, the ASTRO Aspiring Scientists and Physicians Program (ASPP) introduces minority students to radiation oncology through an immersive experience at the ASTRO Annual Meeting. Additionally, programs like the ASTRO-BCRF Radiation Oncology Visiting Away Rotations offer stipends to underrepresented students for clinical and research rotations, fostering early exposure and hands-on experience. Through these programs, radiation oncology aims to cultivate a more inclusive workforce that better represents and serves diverse patient populations.
What is your favorite and least favorite part of the radiation oncology?
The best parts of radiation oncology include being able to make a meaningful difference in the outcomes and/or quality of life for patients with cancer and utilizing exciting and continuously evolving technology to deliver treatments. Many radiation oncologists also enjoy a healthy work-life balance, with reasonable time outside of work to pursue hobbies, spend time with family and enjoy other interests. The worst parts of radiation oncology include administrative burdens (not entirely unique to radiation oncology) and a relatively larger burden of prior authorization requirements from insurance companies.
What opportunities do you have to cross over with other specialties?
Radiation oncologists work with other specialists every day! Optimal care of patients is multidisciplinary and radiation oncologists frequently co-manage patients with medical oncologists, surgical oncologists, other physicians and other health professionals (e.g., dietitians and social workers).
What role does the radiation oncologist play on the care team?
Radiation oncology is a specialty highly dependent on a large care team. In addition to the radiation oncology physician, a successful clinic needs a physicist, radiation therapists, dosimetrists, nurses and many others, including medical assistants and schedulers. Delivery of radiation therapy goes much beyond the physician-patient relationship and heavily relies on this extensive team for stellar care and patient experience. The radiation oncologist is the person who knows the most about the patient’s medical and cancer history, works with the multidisciplinary team to create the optimal care plan and spends a great deal of time with the patient prior to and during treatment. The radiation oncologist is also arguably the care team leader, ensuring that all the moving parts of successful radiation delivery are orchestrated appropriately.
What is the difference between medical oncology and radiation oncology?
Both radiation oncology and medical oncology are very clinic-oriented, which means that most, if not all, of your time is spent seeing patients in the clinic. Both specialties also have the opportunity to take care of cancer patients with both common and complex issues. The major differences between the two specialties are:
The BIG patient picture: what kind of interactions do you want to have with your patients in terms of follow-up? Are you someone who enjoys being the manager of someone's care and being the foundation for most of their needs or do you want to create a relationship that is strong but with periods of quiet time? In radiation oncology, we have extremely strong bonds with our patients but typically play more of a consultant role than a comprehensive care role. We help patients make big life decisions and walk them through those times, but we may not be intimately involved with their other medical conditions. That being said, a great radiation oncologist knows everything about their patient and is always willing to lead the care team.
The Skill: Radiation oncology is a highly technical and procedural field. We have the most cancer training (four years!) of any oncologic specialty because of all the skills we have to gain to use such a dangerous and powerful tool (radiation). We make lots of behind-the-scenes, extremely personalized technical decisions. Medical oncology requires a great deal of knowledge but about medications and systemic cancer therapies; it is arguably less procedural in nature and more pharmacology-based.
Work/life balance in your career: Depending on your practice, work/life balance might be different between radiation oncology and medical oncology. In radiation oncology, you rarely round on patients and call is generally taken from home with a few inpatient consultations that require a trip to the hospital. However, in a great number of medical oncology practices, rounding on hospital patients is more routine and being on-call may be more demanding. Overall, medical oncology may require stretches of time with longer hours in the hospital and more responsibility for patients' non-cancer issues, which may have a greater impact on work/life balance.
Career opportunities: This can be difficult to answer depending on the year, but in general, finding a job as a medical oncologist may be easier than as a radiation oncologist. That being said, radiation oncology does not have any job market issues -- our field is just smaller. Radiation may have slightly fewer indications then systemic therapy, especially since medical oncology also covers blood cancers and can present patients with multiple lines of therapy for every disease. Med Oncs can also get jobs in regular internal medicine. We are heavily limited in opening radiation practices secondary to the large overhead cost of radiation machines, radiation therapists, dosimetrists, physicists, etc. The team required to treat one patient in radiation oncology is much larger than that needed to treat a patient with systemic therapy, therefore radonc jobs are usually in academic or hospital-affiliated settings. Overall, it is becoming more difficult to join privately-owned radiation oncology practices; there may be more such opportunities in medical oncology.
How does radiation oncology intersect with palliative medicine?
Any oncological field, including radiation oncology, has the opportunity to work closely with palliative medicine. Palliative medicine is a key member of the multidisciplinary cancer team. They help manage cancer treatment side effects as well as other issues that may arise secondary to the treatments or disease itself. As an aside, some may believe that radiation therapy itself is generally palliative; although radiation can be used to palliate painful or immediately threatening cancerous lesions, most of radiation oncology is in the definitive — or curative — setting. We are an integral part of the multidisciplinary cancer care team, working to save our patients!
Have you worked with proton therapy and has it changed your approach to treatment planning?
Not all residency programs have access to a proton facility, so not all trainees get proton therapy experience in residency. The benefits of having proton therapy training in residency vary depending on who you ask. Other than gaining a knowledge base of proton radiation to add to your clinical repertoire, training with proton radiation therapy may allow you to apply for jobs that are proton-specific or at a proton center that wants to hire those who have proton training. Pediatric radiation oncology is also more proton-heavy, so proton radiation training may be fruitful. However, in general, proton radiation therapy does not vastly change treatment recommendations, paradigms, or outcomes, in the majority of disease sites.
How long is residency?
Residency is a total of five years. Some institutions have a built in first year of general medicine, while others ask that you apply to a separate internship. The internship can be a pure medicine, pediatric or surgery preliminary year or a combination of fields called a transitional year.
Are there fellowships following residency?
Most radiation oncologists do not do fellowships and fellowships are typically not required to acquire a good job. However, some fellowships are available for those who desire additional training with a specific population or condition (e.g., pediatric radiation oncology) or specialized modalities (e.g., brachytherapy, protons).
Can you specialize in radiation oncology?
Yes! Many radiation oncologists in both private practice and academic settings focus on one, two or a few disease sites. However, others are generalists and treat patients with a broad spectrum of malignant and some benign conditions. You do not need to do a fellowship in a specific disease site in order to treat that site.
Is applying to radiation oncology competitive?
Though there is no absolute cutoff as to scores needed to apply in the field, most programs look favorably at above average board scores, research both in the field and outside the field, class rank and recommendation letters from radiation oncologists.
What if I don't love physics?
You don’t have to love the subject material. Most residency programs in the country teach a formal physics course. Physicians work with physicists to ensure that treatment is delivered accurately to patients.
What is a typical week like as a radiation oncology resident?
A resident's day varies from day to day. As a resident you will typically see consults, follow-ups, throughout the day and be involved in the treatment planning and delivery for a significant portion of your day. On some days, you will perform brachytherapy procedures in your department or in the operating room. Treatment planning typically entails simulating the patient prior to treatment in the appropriate position, outlining tumor volumes and normal structures to plan treatment fields and reviewing treatment plans with dosimetry/physics. In addition, throughout the week, you will also approve port films to ensure patients are treated in the right position. Typically, departments operate Monday through Friday as primarily an outpatient practice.
What is call like for a radiation oncology resident?
Typically call is taken in week long segments from home. Residents on call do not stay in-house, but are available by pager for patient issues and emergency consults. Commonly called emergencies are spinal cord compressions and superior vena cava syndrome which may warrant urgent radiation therapy. The frequency of call depends upon the size of your department.
What was the most difficult part of your training and why?
The most difficult part of training for many residents is the transition from intern to PGY-2 radiation oncology resident, as medical school and intern year generally do not provide a lot of instruction about radiation oncology management. It's a steep learning curve and requires extra hours of preparation and study. Other challenging parts of training for many involve preparing for board exams (radiation biology and radiation physics in PGY-3/PGY-4 year, clinical radiation oncology in PGY-5 year and oral boards the year after graduation).
What is the job availability after residency?
Job availability within radiation oncology, from a numbers standpoint, is fantastic. There are countless jobs available every year, both in community/private-based and academic settings. Just like any other specialty or sub-specialty, however, getting a job in a very particular area, especially an urban center, might present its own set of challenges (the tried and true concept of supply and demand). Also, if you are set on a specific type of academic or private practice job, you may have to be open to any location. Overall, within any job (in and outside of medicine!), it would be great to get all the things you want (type of practice, location, disease site, time in clinic, etc.), but if you end up with 70-80% of your desires, that's great!
How do you see AI’s role in radiation oncology?
Artificial intelligence is playing an increasingly important role in radiation oncology, transforming our approaches to clinical practice, research, and education. In the clinic, AI helps automate complex tasks like treatment planning and optimizing dose distributions, allowing us to deliver treatments with greater precision and fewer errors. It also enhances image analysis and segmentation, making it easier to accurately identify tumors and adjust therapies in real time. On the research front, AI enables us to sift through vast datasets to uncover patterns and predictive biomarkers, accelerating the development of personalized treatment strategies and improving patient outcomes. For residents, AI-powered educational tools and simulations offer immersive learning experiences, helping them gain hands-on expertise with advanced technologies in a safe environment. Overall, AI is driving innovation in radiation oncology by boosting efficiency, elevating patient care and preparing the next generation of oncologists to harness cutting-edge technological advancements.
If you had to start your medical training all over again, would you choose radiation oncology?
In a heartbeat! Rad Onc is one of the best fields in medicine. We receive dedicated oncology training in a five-year residency program, have direct patient care, and get to work in a large multidisciplinary team with cutting edge technology.
Who governs the specialty?
Radiation oncologists receive board certification from the American Board of Radiology. Historically radiologists who received additional training in radiation oncology delivered radiation. As radiation oncology expanded, the specialty created a completely separate residency.
How many boards must a radiation oncologist take to become board certified?
In total radiation oncology residents take four different board examinations. Radiation oncology residents take physics and radiobiology boards after their fourth year of residency, clinical written boards after their fifth year of residency and oral clinical boards one year after completing residency.
How much experience should a medical student have in rad onc prior to applying?
Simply, the more, the better! If you know you’re interested in Rad Onc, start shadowing and get involved in the field early. However, many students do not get exposure to the field until later on in medical school. As long as you are honest about your interests, programs will always understand the background of your experience as long as you are passionate about it.
What are rotation and research opportunities for IMGs planning for radiation oncology residency?
There are a good number of opportunities to rotate in radiation oncology. As a medical student, you can check VSLO for clinical rotations, check individual program websites for opportunities, or even reach out to medical student clerkship directors. After graduation, it may be more challenging to get a hands-on rotation, but observerships should still be available. Research opportunities are not as abundant as clinical rotations mainly because more often than not, there isn't a well-defined role/position for a research assistant in Rad Onc. That being said, it is certainly easier to find a spot in a laboratory for basic science research.
Can an IMG match into radiation oncology? How competitive is the residency process?
Yes, IMGs can match into radiation oncology! On a "competitiveness" spectrum, it is more on the competitive side, however, it is certainly not impossible to match. Showing genuine interest in the field is a major factor, which can be demonstrated through clinical rotations, research involvement and leadership roles. Seize the opportunity in your U.S. clinical rotations to showcase your skills, make connections and find trustworthy mentors. Fellow residents (whether IMG or not) are also very helpful in guiding you through the application process, so please do not hesitate to reach out.
What kind of research experience is expected for radiation oncology applicants? Does it need to be within the radiation oncology field?
Research in the space of oncology is always appreciated. It helps show that you are passionate about the field beyond your clinical love for it. However, some research is always better than no research. Publications can prove your ability to execute and complete complex projects – skills that are invaluable as a radiation oncologist.
Do I need a research year to be a competitive applicant?
Some prospective residents take a research year to gain additional research experience and build their CV, but this is certainly not a requirement for matching into radiation oncology (even into so-called "top" programs). If you think a research year might be helpful or of interest to you, talk to trusted advisors and mentors in radiation oncology if possible.
What rotations other than radiation oncology should we complete prior to residency?
There are no mandatory medical school elective rotations required to match into radiation oncology. However, heme/onc and palliative care may be the most helpful. Depending on your interests, you can also consider surgical oncology, breast surgery, gyn onc, ENT or urology. Of note, aside from doing well on your core medical school/M3 rotations and your radiation oncology rotation(s), any other elective rotations you complete will mostly be of benefit to you and your learning – there are no other "strategic" rotations needed for success in Rad Onc.
Who should write my letters of recommendation?
Many programs recommend that you get at least one letter from a radiation oncologist. Like most specialties we value the opinion of our colleagues. Rotating within your home institution, away electives and research give medical students ample opportunity to connect with individuals within the field who can write letters of recommendation for them during the application process. Getting letters from other fields is not discouraged and may provide a balanced view of applicants.
How many programs should I apply to?
There is no set amount of programs one should apply to. The most important thing is that you are comfortable with how many programs you applied to. When completing the residency matching process, you don't want to have any regrets.
How to navigate the match for matching for intern year?
The most important thing regarding the match for your intern year is making sure that the programs you are ranking high all address your priorities. This may include location, rotation requirements, work life balance, etc. The skills you develop and knowledge you obtain that year will always be important, but make sure the programs you are seeking meet your expectations. I would ask for recommendations from others who have completed intern/prelim/TY year already and get their thoughts on what programs may be best for you as well!
Any advice about preliminary year? Is it wise to get surgical exposure if we are interested in radiation oncology?
Most radiation oncology residents do a transitional year or an internal medicine preliminary year. Exposure to surgical procedures can certainly be helpful to better understand the implications of what your future patients will be going through. Many PGY-1 programs offer formal rotations or electives where spending time in the operating room for oncologic procedures is possible. However, this experience can also be obtained later (e.g., during residency training itself), so you shouldn't worry too much if this isn't an option at the intern year program you match to.
Are people happy in the field?
Radiation oncology is an amazing field that constantly challenges you as an individual. You will be constantly rewarded as you work to improve the health of your patients. The rewards far outweigh the work you will put into the field. We encourage you to face the challenge and join us in the exciting and ever-changing field of radiation oncology.
When do programs begin to offer interviews?
Generally programs wait for the Dean’s Letter to be released on November 1 of the application year. Do not be dismayed if you get rejections before November 1. Some programs will make initial cuts before the Dean’s Letter release date.
How soon should I schedule my interview once I am offered one?
Some programs fill up their interview spots the day they begin offering interviews. It is best to contact the program as soon as possible to schedule interviews or you may lose your spot.
How many interviews do I need to go on?
A good goal is eight or more interviews. If you look at the match statistics released annually from the National Resident Match Program (NRMP), almost all applicants with eight or more interviews match into a residency position.
Where should I interview?
Interview anywhere you will be happy training for four years. If you absolutely know that you do not want to move to a particular location, then consider not applying/interviewing.
How should I prepare for my interview?
Review your research projects, read about the program on their website. Prepare a few stock questions that you will ask at the end of interviews since you will likely be asked, "What questions do you have for me?"
What should I wear?
Dress professionally, wearing clothing and accessories designed for a professional workplace.
How long is the interview day?
As some programs transition back to in-person interviews, the length of the interview days may be different. Most in-person interviews will be an entire day, and most virtual interviews will be a half-day. You can expect to interview with several attendings and residents. Do not be surprised if you interview with physics, radiobiology or physics staff. Some programs use a panel style interview rather than many individual interviews. Programs will generally inform you prior to your interview day of what to expect.
What are some examples of questions asked during radiation oncology interviews?
Rad onc programs mostly want to know how you got interested in radiation oncology and why you are interested. They'll often ask you to explain more about your exposure to the field and your research. Other common questions are similar across all residency programs: tell me about a challenging experience, what are your strengths/weaknesses, where do you see yourself in 5/10/15 years, what are your hobbies.
If a program offered a pre/post-interview social, does this mean I have to attend?
This is a good chance to get to know a program well and interact with residents. Keep in mind, this may be a place you will work for four years. Most programs make decisions based on the actual interviews, so missing the dinner to catch a flight is likely OK. Programs understand how hectic the interview season can be. Programs that do virtual interviews often have a "virtual social" which again is a good time to meet the residents in a more relaxed environment.
Should I send thank you notes?
Aaah, the great thank you note dilemma. Although certainly the polite thing to do, decisions on ranking applicants likely are not affected by thank you notes. Unless a program specifies whether or not to send thank you notes, there is no right or wrong answer. With electronic communication, handwritten thank you notes may be overkill. Also, certainly do not hesitate to email any of the residents or attending with whom you interviewed if you have questions about the program that were not answered. If you are still unsure, consider a second-look interview.
